The three Central Oregon counties placed near the top, middle and bottom of the latest ranking of health by county issued by the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute. But county and state health officials are paying more attention to the individual data points used in the formula rather than the overall ranking.

The rankings take into account dozens of health measures of health behaviors, access to care and socioeconomic factors that affect well-­being and longevity. Deschutes County placed fifth out of the 35 ranked counties in Oregon; Crook came in 22nd and Jefferson 34th, falling largely where the counties appeared in previous years. Wheeler County was not ranked.

“I’m much more interested in what contributes to these and what that says about health behaviors and health outcomes than that one county has better health status than another,” said Dr. Katrina Hedberg, a state health officer and epidemiologist with the Oregon Health Authority’s Public Health Division.

Hedberg said the rankings shed light on the various different factors that contribute to health, and underscore that where you live matters.

“A lot of the rural counties don’t look as good as some of the northwestern and I-5 counties,” she said. “And that’s not necessarily a surprise.”

Deschutes County health officials said that while the county performed well on the various health indicators, its high ranking likely reflects the affluence of the county.

“Our good rank is because we’re in a relatively wealthy and relatively large county, so we have a high average socioeconomic status,” said Dr. George Conway, health services director for Deschutes County. “In the same way, those portions of our county — whether in La Pine or census tracts within Bend — that have a lower socioeconomic status are going to have the most problems because it’s inseparable.”

County health officials track many of the same indicators used in the rankings, so the measures generally weren’t a surprise. But the health department is digging deeper into the data to determine what measures might appear better or worse than their ranking indicates and where to focus their resources.

For example, Deschutes County has worse access to mental health providers than other counties, but has consistently improved access over the past three years and is rapidly closing the gap. The county also scored poorly on air quality, but that was likely due to a particularly bad wildfire season. County officials try to mitigate the impact of poor air quality by providing at-risk residents advance notice of prescribed burns and ample warnings about air quality when wildfires strike.

“But in general, the air quality is very good,” Conway said.

Deschutes County scored well on its sexually transmitted disease rate, but Conway said that might be somewhat misleading. That measure is based solely on chlamydia rates.

“Chlamydia is the most common and the most commonly reported STD, but it’s not the most dangerous,” he said. “So we’re much more concerned about the ones that have more serious potential, which include HIV, syphilis and gonorrhea.”

The county has lowered its chlamydia and gonorrhea rates over the past three years, but both the number and the rate of syphilis infections increased.

Sexually transmitted diseases are an issue for all three Central Oregon counties, and the county health departments are working together to address transmission rates.

“Our STD rates are just mind-numbingly high,” Jefferson County Health Director Michael Baker said. “To come back and have a higher rate than even the Multnomah-Portland area, that’s something we need to change our messaging about or to work with providers differently. That number is just unacceptable.”

Baker said the high rate may be due in part to additional work by the counties to screen and diagnose cases, and then to track and notify sexual partners who may have been infected.

“So we expect it to go up,” Baker said. “But after the initial going up, we really do expect it to start doing down, and we’re not seeing that trend yet.”

Crook and Deschutes also had higher than average rates of excessive drinking and motor vehicle crashes involving alcohol — in a state that has higher rates than the national average.

Conway said that while the alcohol problem in Central Oregon predates the rise of the craft brewing industry, heavy marketing by breweries and wineries in the region may be changing social norms around drinking.

“I think it’s fair to say the public messaging and the commercial messaging in our county are not robustly skeptical about the benefits of consuming alcohol,” he said. “I’m not sure that it helps having things like the Ale Trail.”

That may pit health concerns against economic interests in a region were tourism is a leading industry. In Deschutes County, the health department has been working primarily at preventing underage drinking, and is preparing a campaign to run this summer that targets social norms around public consumption of alcohol.

“We know that people start using very early as teens, even early teens,” Conway said. “And we know that when somebody has their first intoxicating dose of ethanol is closely related to the addiction risk later in life.”

Hedberg said the state relies on proven techniques to reduce excessive drinking through things like added taxes on alcohol and state control of liquor sales. A pint of craft beer or a glass of wine are relatively expensive, she said, and less of an issue for binge drinking. It’s the cheaper, large volume containers of alcohol that are more of a problem.

“It’s a nuanced message,” Hedberg said. “We talk about heavy drinking and alcohol misuse and binge drinking, rather than alcohol is bad.”

Baker said that within counties, health departments are trying to work with other parts of county government as well as other community organizations and businesses to help promote conditions for healthy lifestyles. Rather than pitting health concerns against business interests, they’re making the case the two are inextricably connected.

“People want to come to a healthy community,” he said. “So it does have an economic impact.”

Developers of the rankings say the list is intended to be a conversation starter, to illustrate that where we live influences how long and how well we live. By providing counties with data, local communities can begin to address issues such as housing, access to care, transportation or education.

“Every county, regardless of how it ranks, has strengths to celebrate and challenges to address,” said Janna West ­Kowalski, action learning coach with County Health Rankings. “

She pointed to the example of Klamath County, which despite finishing last in the ranking was the Robert Wood Johnson Foundation’s 2018 Culture of Health Prize winner.

In 2012, county leaders in health and social services formed the Healthy Klamath coalition with a mission of creating a healthier community. Since then, the county has made progress on key outcomes, boosting graduation rates, revitalizing parts of its urban center and reducing crime.

Crook County is undertaking a similar effort. The city of Prineville has sought to get help from a national group to transform the city into a healthier community. When the city failed to get the designation needed to get help, community leaders decided to take on the effort on its own.

“It was really great to see the community step up and say, ‘Let’s create our own,’” said Crook County Health Director Muriel DeLaVergne-Brown. “We’ve been doing a lot of that from the health department, but to see the community doing that has been incredibly successful.”

Kowalski said the rankings are intended to get people motivated and engaged to do something about the issues raised by the measures.